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Regulated Medical Waste TRACKING DOCUMENT# 2953841 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulati CODE AREA 7 UN3291, Regulated Medical Waste, 2275 TVao n.o.s., 6.2, PGII ea.. COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 Q I certify that the information provided is true and correct, and that the generated materials are properly classified, described, w packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the Z U.S. Department of Transportation. f�x ry04-15-2021 C�^ 9:07 AM Mike Margullis N AM E O F COM PAN Y REPRESENTATIVE(Print) SIGNATURE O F REPRESENTATIVE DATE NAMES) O F PERSON S COLLECTING, TRANSPORTING OR UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER CC Med-Waste Systems, LLC (818) 998-5533 of ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 04-15-20219:07 AM Z Pharm waste .r8 n a nn , ¢ 1 F >I certify that the Information provided above Is true and correct and that only untreated medical wastes are contained in this load. I am aware that Qc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. a Evan Lieber 04-15-2021 9:07 AM N AM E O F C O M PAN Y REPRESENTATIVE(Print) SI G N ATU RE O F REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER NAMES) OF PERSON S COLLECTIN G, TRAN SPORTIN G O R UNLOADIN G WASTE INITIALS REGISTRATION NUMBER tV COMPANY NAME TELEPHONE NUMBER O 0- Q ADDRESS DATE MEDICAL WASTE COLLECTED F p nn� a conk. .a ont. a m. a onv a F NI certify that the Information provided above is true and correct and that only untreated medical wastes are contained in this toad./ am aware that w falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Z Z F. NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER } F- U ADDRESS Q w PERM IT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z DISCREPANCY INDICATION SPACE ocQ F- F Z I certify that/have been authorized to accept untreated medical wastes and that i have received the above indicated wastes in accordance with the � requirements outlined in that authorization. F - Q H NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 598-5533 (24 -hr company or other emergency response group telephone) ons.